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Primary PNP > Genitourinary/Nephrology > Flashcards

Genitourinary/Nephrology Flashcards

1
Q

Presence of bacterial infection of urinary tract involving bladder

A

Cystitis

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2
Q

Presence of bacterial infection of urinary tract involving urethra

A

Urethritis

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3
Q

Presence of bacterial infection of urinary tract involving kidney

A

Pyelonephritis

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4
Q

What the most common bacterial agent of all childhood UTIs?

A

Escherichia coli

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5
Q

What are predisposing factors of UTI?

A

Immature kidneys associated with premature and low-birth-weight infants

Congenital urologic abnormalities, reflux, neurogenic bladder

Gender differences in anatomy of urinary tract predisposes females

Dysfunctional voiding

Functional obstruction

Trauma/irritants

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6
Q

What are newborn symptoms of UTI?

A

Irritability, poor feeding, diarrhea, fever, vomiting

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7
Q

What are infants/preschoolers symptoms of UTI?

A

Diarrhea, vomiting, fever, poor feeding, strong/foul-smelling urine

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8
Q

Fever, vomiting, strong/foul-smelling urine, suprapubic or urethral pain, frequency, dysuria, and incontinence

A

What are school-age children symptoms of UTI?

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9
Q

What are differential diagnosis of UTI?

A 
Acute abdomen
Chemical irritation
Vulvovaginitis
Dysfunctional voiding
Sexual abuse
Foreign body
Pelvic inflammatory disease (PID)
Dysfunctional elimination syndrome (DES)
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10
Q

What will urinalysis show for UTI?

A

Presence of urinary leukocyte esterase, nitrate, and blood suggestive of UTI

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11
Q

When is suprapubic aspiration used?

A

When infant/children who cannot void voluntarily when culture is needed urgently

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12
Q

What is considered positive in clean-catch midstream?

A

Colonies of 50,000-100,000 colony forming unit (CFUs)/mL of single organism

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13
Q

What is considered positive in straight catheterization?

A

Colonies > 10,000 CFUs/mL of single or multiple organisms

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14
Q

What is considered positive in suprapubic aspiration?

A

Colonies > 1,000 CFUs/mL of single of multiple organisms

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15
Q

When are radiologic studies needed to rule out UTI?

A

Symptoms of pyelonephritis regardless of age and gender

UTI in any child <3 months of age

Males with first infection and families with second infection, even if not pyelonephritis and child >3 months of age

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16
Q

What is the first step in imagining for UTI?

A

Bladder and renal ultrasound to evaluate structure and developmental anomalies/disorders

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17
Q

Detects regurgitation (reflux) of urine into ureter

A

What is voiding cystourethrogram (VCUG)?

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18
Q

When is VCUG indicated?

A

Renal and bladder ultrasonography reveals hydronephrosis, scarring, or other finds suggestive of VUR

Recurrence of febrile UTI

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19
Q

What are intravenous pyelogram (IVP) or nuclear renal cortisol scans looking for?

A

Detect scarring and examine renal function

Only done if VCUG is positive and possible renal scarring

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20
Q

When is acute dimercaptosuccinic acid (DMSA) used?

A

Done during time of infection to assess acute renal inflammation and/or uptake defects

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21
Q

Who needs parenteral antibiotics for UTI treatment?

A

Newborns, infants, or older children with vomiting or severe symptoms, systemic illness, fever, or unable to take fluids

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22
Q

What is the first-line drugs of choice for UTI older than 2 months old?

A

Trimethoprim-sulfamethoxazole (TMP/SMX) until sensitivities are available

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23
Q

What are other first-line drugs of choice for UTI?

A

Amoxicillin, amoxicillin/clavulanate, sulfisoxazole, cephalexin, nitrofurantoin

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24
Q

When should the first follow up urine culture be collected?

A

72 hours after initiating treatment if symptoms are not resolving

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25
Q

When do VUR grades I-III usually resolve?

A

Usually resolve as child grows if there is no underlying voiding or dysfunctional elimination syndrome

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26
Q

What are ways to prevent UTI?

A

Increased fluid intake

Frequent voiding with complete emptying of bladder

Good perineal hygiene with front-to-back wiping

Avoid bubble bath and other urethral irritants such as powders, sprays, products

Cotton underpants and avoidance of tight-fitting clothing that can irritate are recommended

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27
Q

Involuntary urination after child has reached age when bladder control is usually attained

A

Enuresis

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28
Q

Daytime enuresis

A

Diurnal

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29
Q

Nighttime, especially while sleeping enuresis

A

Nocturnal

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30
Q

When does enuresis typically resolve?

A

Age 5-7 years

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31
Q

At what age is enuresis considered abnormal?

A

After 7th birthday

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32
Q

What is primary enuresis?

A

Child has never attained nighttime dryness for a period of 6 months or more

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33
Q

What is secondary enuresis?

A

Recurrence of incontinence following a period of at least 6 months of dryness

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34
Q

What are common causes of primary enuresis?

A

Small bladder capacity
Toliet-training problems
Delayed maturation of voiding inhibitory reflex
Sleep problems (“deep sleeper”)
Lack of inhibition of antidiuretic hormone (ADH)
Ingestion of increased amounts of fluid
Dysfunctional voiding

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35
Q

What are common causes of secondary enuresis?

A

UTI, diabetes, GU abnormalities, family disruptions, stress

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36
Q

What are common medications of secondary enuresis?

A

Theophylline, diuretics

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37
Q

What are common signs and symptoms of enuresis?

A

Bedwetting or daytime urine leakage

Odor or urine on clothing and/or beeding

Withdrawal/isolation from peers, diminished self-esteem

Hypospadias, epispadias

Labial fusion

Dribbling of urine during examination

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38
Q

What are differential diagnosis of enuresis?

A 
UTI
Ectopic ureter
Mechanical obstruction
Dysfunctional voiding
Dysfunctional elimination syndrome (constipation)
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39
Q

How do you diagnosis enuresis?

A

Urinalysis/urine culture

Renal ultrasound/vesicoureterogram

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40
Q

How to treat primary nocturnal?

A

Limit fluid intake after dinner
Double voiding before bedtime
Avoid punishment/criticism
Usually self-limited

Spontaneous resolution of 10% per year after 5 years of age

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41
Q

What therapies can be used to treat enuresis?

A

Motivational therapy–verbal praise for dryness, reward system, dryness calendar

Conditioning therapy–triggered by urine, children awakened by alarm, alarm sensitizes child to sensation of full bladder

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42
Q

What pharmacologic treatment for enuresis?

A

Desmopressin acetate

Imipramine

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43
Q

Absence of one or both tests in scrotal sac due to failure of normal descent from abdomen during fetal development

A

Cryptorchidism

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44
Q

What are differential diagnosis for cryptorchidism?

A

Retractile testes
Ectopic testes
Aorchia
Chromosomal disorders

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45
Q

What do palpable testes with cryptorchidism signal?

A

May be retractile or ectopic

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46
Q

What do non palpable testes with cryptorchidism signal?

A

May be abdominal or absent

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47
Q

When does spontaneous descents usually occur for cryptorchidism?

A

By 6 months

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48
Q

What treatments for cryptorchidism if not descended by 1 year?

A

Hormonal therapy or surgical intervention (orchiopexy)

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49
Q

What are the potential complications for cryptorchidism?

A

Infertility
Testicular malignancy
Hernia

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50
Q

Painless scrotal swelling due to collection of peritoneal fluid within tunica vaginalis surrounding scrotum?

A

Hydrocele

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51
Q

What is noncommunicating type hydrocele?

A

Tunica vaginalis is closed, limiting fluid collection to scrotum; size of hydrocele is constant

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52
Q

What is communicating type hydrocele?

A

Tunica vaginalis remains open, allowing fluid to flow between peritoneum and hydrocele sac; associated with hernia

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53
Q

Swelling in scrotum (alternating or fixed) that may be painful if full or tense secondary to coughing or straining

Smaller on awakening and enlarges as day progresses

Fluctuance

Translucent with transillumination

A

What are signs and symptoms of hydrocele?

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54
Q

What are differential diagnoses for hydrocele?

A 
Cryptorcidism
Retractile testes
Hernia
Inguinal lymphadenopathy
Patent processus vaginalis
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55
Q

What is management for noncommunicating hydrocele?

A

Most resolve spontaneously without intervention

Refer is persists beyond 1 year, increase in size, or causes discomfort

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56
Q

What is management for communicating hydrocele?

A

Occasional spontaneous resolution
Frequently develops into hernia requiring surgical intervention
Refer for surgical evaluation if persist beyond 1 year

57
Q

Congenital defect with urethral meatus on ventral surface of penis

A

Hypospadias

58
Q

Which population does hypospadias typically occur?

A

Caucasians

59
Q

What is the management for hypospadias?

A

Avoid circumcision; refer to pediatric urology

For mild cases, primarily cosmetic surgery

For increasing severity, functional, psychological, and cosmetic surgery–repair early 6-18 months

60
Q

Narrow, non retractile foreskin of childhood; not fully retractable to expose glans

A

Phimosis

61
Q

Uncircumcised newborns may not be able to be able to fully retract until WHAT AGE?

A

10 years or older

62
Q

Inability to replace foreskin over glands after retraction

A

Paraphimosis

63
Q

What are signs and symptoms of phimosis?

A

May be asymptomatic, painful urination, weak urine stream, ballooning of foreskin when urinating

64
Q

What are signs and symptoms of paraphimosis?

A

Pain/tenderness

65
Q

What are differential diagnoses of phimosis/paraphimosis?

A

Balanitis

Balanoposthitis

66
Q

How do you treat phimosis?

A

Maintain good hygiene
Only gentle stretch of foreskin during bath
If there is urinary obstruction, circumcision may be required

67
Q

What is the treatment for paraphimosis?

A

Goal: reduction of swelling to reduce foreskin

Ice, application of granulated sugar to penis, or wrapping distal penis in saline-soaked gauze and applying pressure for 5-10 minutes

Injection of hyaluronidase beneath the band to release it

68
Q

Narrowing of distal end of urethra

A

Meatal stenosis

69
Q

What the most common cause of meatal stenosis?

A

Postcircumcision 11%

70
Q

What are signs and symptoms of meatal stenosis?

A

Penile pain/discomfort with urination
Narrow, dorsally diverted urine stream
High-velocity urine stream
Occasional bleeding following void

Inflammation of glands
Slit-like or narrowed meatus

71
Q

What are differential diagnoses for meatal stenosis?

A

Hypospadis

Chordee

72
Q

What is treatment for meatal stenosis?

A

Air exposure
Warm soaks/baths
Frequent diaper change
Meatotomy may be necessary

73
Q

Torsion of spermatic cord that can result in gangrene of testes (emergency)

A

Testicular torsion

74
Q

When does testicular torsion usually occur?

A

In adolescent males

75
Q

What is common signs and symptoms of testicular torsion?

A

Acute, painful swelling of scrotum
Nausea, vomiting, anorexia
Minimal fever
Lack of urinary symptoms is normal

76
Q

What are common presentation for testicular torsion?

A

Not unusual to awaken with pain, but can develop after scrotal trauma or increased activity

77
Q

What are differential diagnoses of testicular torsion?

A

Trauma
Ochitis
Acute epididymitis
Hydrocele

78
Q

What are physical findings of testicular torsion?

A

Enlarged, highly render testis
Scrotum on involved side edematous, warm erythematous
Anxious patient, resistant to movement
Lifting testis does not relieve pain
Solid mass may be visualized with transillumination

79
Q

What is Prehn’s sign?

A

Lifting testis does not relieve pain

80
Q

What are diagnostic testing for testicular torsion?

A

CBC–slight increase in WBC
Doppler ultrasound–diminished blood flow
Urinalysis–usually normal

81
Q

What is management for testicular torsion?

A

Immediate surgery referral within first 6 hours

82
Q

Blood in urine is visible to naked eye that causes urine to appear tea or cola colored

A

Gross hematuria

83
Q

Blood is not visible with naked eye, but is detectable with a microscope; can be persistent or transient

A

Microscopic hematuria

84
Q

What are signs and symptoms of hematuria?

A

Visible blood in urine; may be found in urinalysis prompted by urinary or other symptoms

Pain varies with many children experiencing no pain and some children reporting discomfort/pain

85
Q

What is treatment for hematuria?

A

Infections are treated with antibiotics

Trauma with dramatic injury to kidney or bladder–surgical intervention

Stones treated depending on type, size, and location–prevention further stones

Trauma with bruising but no laceration to kidney will require only rest and appropriate time to heal

Kidney disease treated with situational- and stage-appropriate interventions

86
Q

What will urine dipstick/reagent strip show for hematuria?

A

Can detect 5-10 intact RBCs/micro L

87
Q

What will microscopic exam show for hematuria?

A

Positive dipstick result is confirmed by microscopic examination of sediment of 10-15 ml of centrifuged fresh urine

88
Q

Presence of abnormal levels of protein in urine; more than 100-150 mg/m2/day

A

Proteinuria

89
Q

What are causes of transient proteinuria?

A

Idiopathic, fever, seizure, vigorous exercise, dehydration, stress, cold exposure

90
Q

What are causes of persistent proteinuria?

A

Glomerular factors related to nephron loss, reflux nephropathy related to VUR, Alport syndrome, glomerulopathy, infection, malignancy, toxin

91
Q

What are signs and symptoms of proteinuria?

A

Usually asymptomatic

Change in urine volume, change in urine color, increased BP or edema, recent streptococcal infection

92
Q

What are differential diagnoses of proteinuria?

A 
Transient proteinuria
Orthostatic proteinuria
Persistent proteinruia
Diabetes mellitus
Glomerulopathy
Vascular disease or vasxulitis
Alport syndrome
Nephron loss (due to disease, infection, insult)
93
Q

What does urine dipstick show for proteinuria?

A

Greater than or equal to 1+

94
Q

What does quantitative urine assessment for proteinuria?

A

May show persistent dipstick positive proteinuria; limited use to difficulty in accurately and completely collecting 24 hours of urine

95
Q

What does sulfosalicylyc acid show for proteinuria?

A

Measures all proteins in urine but is infrequently use din children

96
Q

What is treatment for transient proteinuria?

A

Retest in 1 year to confirm

97
Q

What is treatment for persistent proteinuria?

A

Refer to pediatric nephrologist

98
Q

Disease characterized by diffuse inflammatory changes in glomeruli that is immune-mediated response

A

Glomerulonephritis

99
Q

What is the most common cause of primary acute glomerulonephritis?

A

Poststreptococcal glomerulonephritis

100
Q

What is the chronic form of glomerulonephritis normally seen in?

A

Immunoglobulin A (IgA) nephropathy

101
Q

What are signs and symptoms of acute glomerulonephritis?

A

Hematuria
Decreased urine output
Edema
Dark urine (acute poststreptococcal glomerulonephritis (APSGN))

102
Q

What are signs and symptoms of chronic disease of glomerulonephritis?

A

Fatigue

Failure to thrive

103
Q

What are differential diagnoses of glomerulonephritis?

A 
Benign hematuria
Hereditary nephropathy
Systemic lupus erythematosus
Anaphylactoid purpura
IgA nephropathy
Henoch-Schonlein Purpura (HSP)
104
Q

What are physical signs of glomerulonephritis?

A

Gross hematuria
Facial (periorbital) edema in the morning
Hypertension with or without renal insufficiency
Costovertebral angel (CVA) tenderness

105
Q

What are results of urinalysis for glomerulonephritis?

A 
Cast--RBCs, leukocytes, and/or casts
Hematuria
Protein
low pH
Increased specific gravity
106
Q

What will titers show for glomerulonephritis?

A

Serum antistreptolysin O (ASO)
Anti-strepto hyalurinodase test (AHT)
anti-DNase B

107
Q

What will chest radiograph show for glomerulonephritis?

A

Pulmonary edema

108
Q

What will management be for glomerulonephritis?

A

Hypertension/relieve edema–fluid restriction, diuretics, vasodilators
Antibiotics–penicillin if throat and skin infection persists

109
Q

Unilateral or bilateral dilation of kidney(s)

A

Hydronephrosis

110
Q

Anatomic block of urine from kidney or back flow of urine into kidneys as in VUR

A

Hydronephrosis

111
Q

What is the most common site of obstruction for hydronephrosis?

A

Ureteropelvic junction (UPJ)

112
Q

What are signs and symptoms of hydronephrosis?

A 
Nusea
Abdominal/flank pain
Decreased urine output
Failure to thrive
VUR
Posterior urethral valves
113
Q

What are differential diagnoses for hydronephrosis?

A 
Prune belly syndrome
UPJ obstruction
Ectopic ureterocele
Urethral/uretrrovesicular obstructions
BUR
Posterior urethral valves
114
Q

What is treatment for hydronephrosis?

A

Surgery to relieve obstruction

Must follow-up long-term for continued assessment of renal function

115
Q

Detect in normal urine acidification with resulting persistent metallic acidosis

A

Renal tubular acidosis

116
Q

What is type 1 renal tubular acidosis (RTA)?

A

Defect in distal tube secretion of hydrogen ions

117
Q

What is type 2 renal tubular acidosis (RTA)?

A

Defect in reabsorption of bicarbonate

118
Q

What are signs and symptoms of renal tubular acidosis?

A

Growth failure
GI complaints
Muscle weakness

119
Q

What are differential diagnoses for renal tubular acidosis?

A

Diarrhea
Diabetes mellitus
Renal failure
Lactic acidosis

120
Q

What will urine pH show for renal tubular acidosis?

A

First morning specimen
pH <5.5 = proximal RTA
pH >5.7 = distal RTA

121
Q

What will electrolytes look like for renal tubular acidosis?

A

Serum bicarbonate less than 16 mEq

Hyperkalemia

122
Q

What is the goal for renal tubular acidosis?

A

Achieve optimal growth and bone mineralization and prevent nephrocalcinosis and progression to renal failure

123
Q

How do you treat acidosis for renal tubular acidosis?

A

Balance serum bicarbonate to normal level

124
Q

What are risk factors for renal tubular acidosis?

A

Risk of nephrocalcinosis, renal failure due to continuous alkali therapy and long-term clinical monitoring

125
Q

What does high-grade vesicoureteral reflux result in?

A

Renal scarring, eventual hypertension, and renal failure

126
Q

What does a febrile infant with UTI undergo?

A

Renal and bladder ultrasonography

127
Q

What are the most common oral antibiotics for UTI?

A 
Trimethroprim/sulfamethoxazole
Cephalosporins
Amoxicillin
Sulfisoxazole
Nitrofurantoin
128
Q

How soon do you need to follow up for UTI?

A

2 days

129
Q

Who classifies as a need for renal ultrasound after first UTI?

A

febrile infants

children 2-24 months (whether febrile or not)

130
Q

What is chordee?

A

Ventral bowing of penis

131
Q

What are signs and symptoms of hypospadias?

A

Dorsally hooded foreskin

Urinary stream that aims downward

132
Q

What is the best age to do surgery for hypospadias?

A

Around 6-12 months

133
Q

If there is bilateral cryptorchidism, what should be done?

A

Karotyping for chromosomal abnormalities

134
Q

What children at risk for with cryptorchidism?

A

Testicular cancer

135
Q

When pain is relieved by elevated scrotum, what should be expected?

A

Epididymitis

136
Q

When pain is not relieved by elevating scrotum, what should be expected?

A

Testicular torsion

137
Q

What is primary dysmenorrhea?

A

Absence of any pelvic pathology

Etiology is thought to be hormonal and endocrine-related

Most causes begin 6-12 months after menarche with symptoms gradually increasing util patient are in mid-20s

138
Q

What are sign and symptoms of dysmenorrhea?

A

Painful menses

Lower abdominal pain associated with menstruation, usually worse in the first few days of bleeding

Back pain

Nausea, vomiting, fatigue, headache, diarrhea

139
Q

What do you treat dysmenorrhea?

A

Heat application
Psychological support
OTC analgesics (ibuprogren 400 mg Q4-6hr, best to start 2 days before cycle and continue until 2 days after cycle finishes)

Stronger NSAIDs for moderate to severe cases

Oral contraceptives

Primary PNP (8 decks)

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